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Elalouf A, Elalouf H, Rosenfeld A. Modulatory immune responses in fungal infection associated with organ transplant - advancements, management, and challenges. Front Immunol 2023; 14:1292625. [PMID: 38143753 PMCID: PMC10748506 DOI: 10.3389/fimmu.2023.1292625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Organ transplantation stands as a pivotal achievement in modern medicine, offering hope to individuals with end-stage organ diseases. Advancements in immunology led to improved organ transplant survival through the development of immunosuppressants, but this heightened susceptibility to fungal infections with nonspecific symptoms in recipients. This review aims to establish an intricate balance between immune responses and fungal infections in organ transplant recipients. It explores the fundamental immune mechanisms, recent advances in immune response dynamics, and strategies for immune modulation, encompassing responses to fungal infections, immunomodulatory approaches, diagnostics, treatment challenges, and management. Early diagnosis of fungal infections in transplant patients is emphasized with the understanding that innate immune responses could potentially reduce immunosuppression and promise efficient and safe immuno-modulating treatments. Advances in fungal research and genetic influences on immune-fungal interactions are underscored, as well as the potential of single-cell technologies integrated with machine learning for biomarker discovery. This review provides a snapshot of the complex interplay between immune responses and fungal infections in organ transplantation and underscores key research directions.
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Affiliation(s)
- Amir Elalouf
- Department of Management, Bar-Ilan University, Ramat Gan, Israel
| | - Hadas Elalouf
- Information Science Department, Bar-Ilan University, Ramat Gan, Israel
| | - Ariel Rosenfeld
- Information Science Department, Bar-Ilan University, Ramat Gan, Israel
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Elalouf A. Infections after organ transplantation and immune response. Transpl Immunol 2023; 77:101798. [PMID: 36731780 DOI: 10.1016/j.trim.2023.101798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/08/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
Organ transplantation has provided another chance of survival for end-stage organ failure patients. Yet, transplant rejection is still a main challenging factor. Immunosuppressive drugs have been used to avoid rejection and suppress the immune response against allografts. Thus, immunosuppressants increase the risk of infection in immunocompromised organ transplant recipients. The infection risk reflects the relationship between the nature and severity of immunosuppression and infectious diseases. Furthermore, immunosuppressants show an immunological impact on the genetics of innate and adaptive immune responses. This effect usually reactivates the post-transplant infection in the donor and recipient tissues since T-cell activation has a substantial role in allograft rejection. Meanwhile, different infections have been found to activate the T-cells into CD4+ helper T-cell subset and CD8+ cytotoxic T-lymphocyte that affect the infection and the allograft. Therefore, the best management and preventive strategies of immunosuppression, antimicrobial prophylaxis, and intensive medical care are required for successful organ transplantation. This review addresses the activation of immune responses against different infections in immunocompromised individuals after organ transplantation.
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Affiliation(s)
- Amir Elalouf
- Bar-Ilan University, Department of Management, Ramat Gan 5290002, Israel.
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Fariñas MC, González-Rico C, Fernández-Martínez M, Fortún J, Escudero-Sanchez R, Moreno A, Bodro M, Muñoz P, Valerio M, Montejo M, Nieto J, Ruiz-San Millan JC, Casafont-Morencos F, Martinez-Martínez L, Fariñas-Álvarez C. Oral decontamination with colistin plus neomycin in solid organ transplant recipients colonized by multidrug-resistant Enterobacterales: a multicentre, randomized, controlled, open-label, parallel-group clinical trial. Clin Microbiol Infect 2020; 27:856-863. [PMID: 33359562 DOI: 10.1016/j.cmi.2020.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/12/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the efficacy of oral colistin-neomycin in preventing multidrug-resistant Enterobacterales (MDR-E) infections in solid organ transplant (SOT) recipients. METHODS Multicentre, open-label, parallel-group, controlled trial with balanced (1:1) randomization in five transplant units. SOT recipients were screened for MDR-E intestinal colonization (extended-spectrum β-lactamase or carbapenemase producing) before transplantation and +7 and + 14 days after transplantation and assigned 1:1 to receive treatment with colistin sulfate plus neomycin sulfate for 14 days (decolonization treatment (DT) group) or no treatment (no decolonization treatment (NDT) group). The primary outcome was diagnosis of an MDR-E infection. Safety outcomes were appearance of adverse effects, mainly diarrhoea, rash, nausea and vomiting. Patients were monitored weekly until 30 days after treatment. Intention-to-treat analysis was performed. RESULTS MDR-E rectal colonization was assessed in 768 SOT recipients; 105 colonized patients were included in the clinical trial, 53 receiving DT and 52 NDT. No significant decrease in the risk of infection by MDR-E was observed in the DT group (9.4%, 5/53) compared to the NDT group (13.5%, 7/52) (relative risk 0.70; 95% confidence interval 0.24-2.08; p 0.517). Four patients (5.6%), three (5.6%) in the DT group and one (1.9%) in the NDT group, developed colistin resistance. Twelve patients (22.7%) in the DT group had diarrhoea, eight related to treatment (15.0%); one patient (1.8%) developed skin rash and another (1.8%) nausea and vomiting. Two patients (3.8%) in the NDT group developed diarrhoea. CONCLUSIONS DT does not reduce MDR-E infections in SOT. Colistin resistance and adverse effects such as diarrhoea are a potential issue that must be taken seriously.
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Affiliation(s)
- Maria Carmen Fariñas
- Infectious Diseases Service, Hospital Universitario Marques de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Claudia González-Rico
- Infectious Diseases Service, Hospital Universitario Marques de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | | | - Jesús Fortún
- Infectious Diseases Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañon, IiSGM, Universidad Complutense de madrid, Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañon, IiSGM, Universidad Complutense de madrid, Madrid, Spain
| | - Miguel Montejo
- Infectious Diseases Unit, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
| | - Javier Nieto
- Infectious Diseases Unit, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
| | | | | | - Luis Martinez-Martínez
- Unit of Microbiology, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Cordoba, Cordoba, Spain
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Yooprasert P, Rotjanapan P. BK Virus-Associated Nephropathy: Current Situation in a Resource-Limited Country. Transplant Proc 2018; 50:130-136. [PMID: 29407295 DOI: 10.1016/j.transproceed.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/25/2017] [Accepted: 11/03/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Data on BK virus-associated nephropathy (BKVAN) and treatment strategy in a resource-limited country are scarce. This study aimed to evaluate epidemiology of BKVAN and its situation in Thailand. METHODS A retrospective analysis was conducted among adult kidney transplant recipients at Ramathibodi Hospital from October 2011 to September 2016. Patients' demographic data, information on kidney transplantation, immunosuppressive therapy, cytomegalovirus and BK virus infections, and allograft outcomes were retrieved and analyzed. RESULTS This study included 623 kidney transplant recipients. Only 327 patients (52.49%) received BK virus infection screening, and 176 of 327 patients had allograft dysfunction as a trigger for screening. BKVAN was identified in 39 of 327 patients (11.93%). Deceased donor transplantation and cytomegalovirus infection were associated with a higher risk of BKVAN (odds ratio = 2.2, P = .024, 95% confidence intervals [1.1, 4.43], and odds ratio = 2.6, P = .006, 95% confidence intervals [1.29, 5.26], respectively). BKVAN patients were at significantly higher risk for allograft rejection (P < .001) and allograft failure (P = .036). At the end of the study, 4 graft losses were documented (12.12%). CONCLUSIONS BKVAN was associated with high rate of allograft rejection and failure. However, surveillance of its complications has been underperformed at our facility. Implementing a formal practice guideline may improve allograft outcome in resource-limited countries.
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Affiliation(s)
- P Yooprasert
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - P Rotjanapan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Camargo JF, Simkins J, Schain DC, Gonzalez AA, Alcaide ML, Anjan S, Guerra G, Roth D, Kupin WL, Mattiazzi A, Tan Y, Milikowski C, Morris MI, Abbo LM. A cluster of donor-derivedCryptococcus neoformansinfection affecting lung, liver, and kidney transplant recipients: Case report and review of literature. Transpl Infect Dis 2018; 20:e12836. [DOI: 10.1111/tid.12836] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/14/2017] [Accepted: 10/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jose F. Camargo
- Department of Medicine; Division of Infectious Diseases; University of Miami Miller School of Medicine; Miami FL USA
| | - Jacques Simkins
- Department of Medicine; Division of Infectious Diseases; University of Miami Miller School of Medicine; Miami FL USA
| | - Denise C. Schain
- Department of Medicine; Division of Infectious Diseases; University of Florida School of Medicine; Gainesville FL USA
| | - A. Adrian Gonzalez
- Department of Medicine; Division of Infectious Diseases; University of Florida School of Medicine; Gainesville FL USA
| | - Maria L. Alcaide
- Department of Medicine; Division of Infectious Diseases; University of Miami Miller School of Medicine; Miami FL USA
| | - Shweta Anjan
- Department of Medicine; Division of Infectious Diseases; University of Miami Miller School of Medicine; Miami FL USA
| | - Giselle Guerra
- Department of Medicine; Division of Nephrology; University of Miami Miller School of Medicine; Miami FL USA
| | - David Roth
- Department of Medicine; Division of Nephrology; University of Miami Miller School of Medicine; Miami FL USA
| | - Warren L. Kupin
- Department of Medicine; Division of Nephrology; University of Miami Miller School of Medicine; Miami FL USA
| | - Adela Mattiazzi
- Department of Medicine; Division of Nephrology; University of Miami Miller School of Medicine; Miami FL USA
| | - Yaohong Tan
- Department of Pathology and Laboratory Medicine; University of Miami Miller School of Medicine; Miami FL USA
| | - Clara Milikowski
- Department of Pathology and Laboratory Medicine; University of Miami Miller School of Medicine; Miami FL USA
| | - Michele I. Morris
- Department of Medicine; Division of Infectious Diseases; University of Miami Miller School of Medicine; Miami FL USA
| | - Lilian M. Abbo
- Department of Medicine; Division of Infectious Diseases; University of Miami Miller School of Medicine; Miami FL USA
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Camargo JF. Donor-derived infections in solid organ transplant recipients: Challenging the 30-day paradigm. Transpl Infect Dis 2017; 19. [PMID: 28100037 DOI: 10.1111/tid.12665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 10/30/2016] [Accepted: 11/13/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Jose F Camargo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Uribe LG, Cortés JA, Granados CE, Montoya JG. Antifungal prophylaxis following heart transplantation: systematic review. Mycoses 2014; 57:429-36. [DOI: 10.1111/myc.12179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/12/2014] [Accepted: 01/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Luis G. Uribe
- Department of Medicine; Division of Infectious Diseases and Geographic Medicine; Stanford University School of Medicine; Stanford CA USA
- Department of Internal Medicine; School of Medicine; Universidad Nacional de Colombia; Bogotá Colombia
- Fundación Cardiovascular de Colombia; Bucaramanga Colombia
| | - Jorge A. Cortés
- Department of Internal Medicine; School of Medicine; Universidad Nacional de Colombia; Bogotá Colombia
| | - Carlos E. Granados
- Department of Internal Medicine; School of Medicine; Universidad Nacional de Colombia; Bogotá Colombia
| | - José G. Montoya
- Department of Medicine; Division of Infectious Diseases and Geographic Medicine; Stanford University School of Medicine; Stanford CA USA
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Rodríguez-Serrano M, Sánchez-Lázaro I, Almenar-Bonet L, Martínez-Dolz L, Portolés-Sanz M, Rivera-Otero M, Salvador-Sanz A. Does the calcineurin inhibitor have influence on cytomegalovirus infection in heart transplantation? Clin Transplant 2013; 28:88-95. [PMID: 24325305 DOI: 10.1111/ctr.12282] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 12/19/2022]
Abstract
Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in heart transplant (HTx). Our aim was to analyze the rate of CMV infection in HTx patients receiving treatment with cyclosporine (CsA) or tacrolimus (Tac). Ninety-five patients were randomized to receive either CsA (53.7%) or Tac (46.3%). We performed prophylaxis with valganciclovir in patients with the highest risk of CMV infection. We considered CMV infection as an increased viral load or the presence of CMV in histological samples. We analyzed baseline characteristics, CMV infection, and other complications. Event-free rates were calculated using the Kaplan-Meier method. There were no significant differences in baseline characteristics between both groups. CMV infection was detected in 31.6% of patients (in 66.7% due to asymptomatic replication). The group treated with Tac had a lower rate of CMV infection (15.9% vs. 45.1%, p = 0.002) and longer CMV infection-free survival time (1440 vs. 899 d, p = 0.001). No differences were observed in the complications analyzed in both groups. The independent risk factors for infection identified in the multivariate analysis were treatment with CsA and bacterial infections. This was the first study to demonstrate a lower rate of CMV infection in patients treated with Tac vs. those treated with CsA after HTx.
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Affiliation(s)
- María Rodríguez-Serrano
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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